This form must be completed by the student and submitted to the Thesis Coordinator to gain credit for experience. All Internships must be approved the Thesis Coordinator. A total of 60 hours of internship experience is required along with attendance at two class meetings in order to receive full credit. Students are required to keep a journal that will include regular entries. The journal may be entered in the computer, as a blog, or good old-fashioned notebook.
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Student name Phone
Number of internship credits requested for this Internship: __________
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Primary e-mail address
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Name of Internship site
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Name of supervisor Title
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Address City State Zip
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Phone E-mail
Internship start date: __________ End date: ___________
Position or Function:
Student must attach a typed essay describing how this internship experience compliments your educational and vocational goals and how it is enhances your education. Students are also required to keep a journal and discuss their experience during a scheduled class time.
Supervisor feedback on performance (to be completed by Thesis Coordinator/Director via phone, in person, or via e-mail interview with supervisor):
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CCS THESIS COORDINATOR OR DIRECTOR DATE
Turn in signed and completed form after Internship to Records for credit.